Form 8038-B Draft - Information Return For Build America Bonds And Recovery Zone Economic Development Bonds Page 3

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Form 8038-B (Rev. 11-2012)

Page

Amount

Part V

Use of Proceeds of Issue

(Whole Dollars)

Sales proceeds .

Expected investment proceeds

Proceeds used for accrued interest

DRAFT AS OF

Proceeds used for bond issuance cost (including underwriter's discount) .

Proceeds used for credit enhancement .

Proceeds allocated to a reasonably required reserve fund .

Proceeds used for capital expenditures .

Proceeds used for working capital expenditures .

Proceeds used to currently refund prior issues

August 8, 2012

July 19, 2012

Proceeds used to advance refund prior issues

Part VI

Description of Refunded Bonds (complete this part only for refunding bonds)

Enter the remaining weighted average maturity of the bonds to be

years

currently refunded .

Enter the remaining weighted average maturity of the bonds to be

years

advance refunded .

Enter the last date on which the refunded bonds will be called (MM/DD/YYYY)

DO NOT FILE

Enter the date the refunded bonds were issued (if more than one date of issue, attach a statement)

(MM/DD/YYYY) (see instructions) .

Part VII

Miscellaneous

Enter the amount of the volume cap allocated to the issue (see instructions) (attach volume cap certification)

2 a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract

(GIC)

b Enter the final maturity date of the GIC (MM/DD/YYYY)

▶

c Enter the name of the GIC provider

▶

Proceeds of this issue that are to be used to make loans to other governmental units .

4 a If this issue is a loan made from the proceeds of another issue, check box

and enter the following information:

▶

b Enter the issue date of the master pool obligation (MM/DD/YYYY)

▶

c Enter the EIN of the issuer of the master pool obligation

▶

d Enter the name of the issuer of the master pool obligation

▶

5 a If the issuer entered into a hedge, check box

and enter the following information:

▶

b Name of hedge provider

▶

c Type of hedge

▶

d Term of hedge

▶

If the issuer has superintegrated the hedge, check box

▶

If the issuer elected to pay a penalty in lieu of arbitrage rebate, check box

▶

If the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remediated in accordance

with the requirements under Regulations section 1.141-12, check box

▶

If the issuer has established written procedures to monitor the requirements of section 148, check box

▶

Under penalties of perjury, I declare that I have examined this return, and accompanying schedules and statements, and to the best of my knowledge and

belief, they are true, correct, and complete. I further declare that I consent to the IRS's disclosure of the issuer's return information, as necessary to process

Signature

the return, to the person(s) that I have authorized above.

and

Consent

Signature of issuer's authorized representative

Date

Type or print name and title

Print/Type preparer’s name

Preparer's signature

Date

PTIN

Paid

Check

self-employed

Preparer

Use Only

Firm’s name

Firm's EIN

▶

Firm's address

Phone no.

▶

Part VIII

Consent to Disclosure of Certain Information from this Return

For build America bonds that provide a tax credit to bondholders, does the issuer give the IRS consent to publish, through a

website or in a publication, its name and address, employer identification number, name and description of bond issue, date of

issuance, CUSIP number, issue price, final maturity date, and stated redemption price at maturity, to assist in the proper reporting

of interest, tax credits, or other benefits under section 6049 and Regulations thereunder? .

▶

Yes

Under penalties of perjury, I declare that I am an officer of the above named issuer and that I am authorized to give consent on behalf of the above named issuer for the IRS

to publish the items of information described in line 1 of Part VIII of this form to assist in the reporting obligations under section 6049.

Sign

Here

Signature

Date

Type or print name and title

8038-B

Form

(Rev. 11-2012)